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Anatomical basis of fascial plane blocks
  1. Ki Jinn Chin1,
  2. Barbara Versyck2,3,
  3. Hesham Elsharkawy4,5,
  4. Maria Fernanda Rojas Gomez6,
  5. Xavier Sala-Blanch7,8 and
  6. Miguel A Reina9
  1. 1 Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Anaesthesia and Pain Medicine, Catharina Ziekenhuis, Eindhoven, North Brabant, The Netherlands
  3. 3 Department of Anaesthesia and Pain Medicine, AZ Turnhout, Turnhout, Belgium
  4. 4 Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5 Department of Anesthesiology, Case Western Reserve University, MetroHealth Pain and Healing Center, Cleveland, Ohio, USA
  6. 6 Anesthesiology, Clinica Cirulaser Andes, Bogotá, Colombia
  7. 7 Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
  8. 8 Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
  9. 9 Department of Anesthesiology, Madrid-Monteprincipe University Hospital, CEU-San-Pablo University School of Medicine, Madrid, Spain
  1. Correspondence to Dr Ki Jinn Chin, Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada, M5T 2S8; gasgenie{at}gmail.com

Abstract

Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space (“plane”) between two discrete fascial layers is the target of needle insertion and injection. Analgesia is primarily achieved by local anesthetic spread to nerves traveling within this plane and adjacent tissues. This narrative review discusses key fundamental anatomical concepts relevant to FPBs, with a focus on blocks of the torso. Fascia, in this context, refers to any sheet of connective tissue that encloses or separates muscles and internal organs. The basic composition of fascia is a latticework of collagen fibers filled with a hydrated glycosaminoglycan matrix and infiltrated by adipocytes and fibroblasts; fluid can cross this by diffusion but not bulk flow. The plane between fascial layers is filled with a similar fat-glycosaminoglycan matric and provides gliding and cushioning between structures, as well as a pathway for nerves and vessels. The planes between the various muscle layers of the thorax, abdomen, and paraspinal area close to the thoracic paravertebral space and vertebral canal, are popular targets for ultrasound-guided local anesthetic injection. The pertinent musculofascial anatomy of these regions, together with the nerves involved in somatic and visceral innervation, are summarized. This knowledge will aid not only sonographic identification of landmarks and block performance, but also understanding of the potential pathways and barriers for spread of local anesthetic. It is also critical as the basis for further exploration and refinement of FPBs, with an emphasis on improving their clinical utility, efficacy, and safety.

  • anesthesia
  • conduction
  • pain management
  • regional anesthesia
  • chronic pain

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Footnotes

  • Twitter @barbaraversyck, @kaohesham

  • Contributors KJC contributed to the conception, research, writing, illustration, and editing of the paper. BV contributed to the conception, research, writing, and editing of the paper. HE contributed to the conception, research, writing, and editing of the paper. MFRG contributed to the conception, writing, illustration, and editing of the paper. XS-B contributed to the illustration and editing of the paper. MAR contributed to the illustration and editing of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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